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Is it possible to tear or rupture an ACL from taking a awkward step down a stair? - or - what did I do to my knee?

Question: Is it possible to tear or rupture an ACL from taking a awkward step down a stair? - or - what did I do to my knee?

Hello -

My history: 34 year male, very active. Plays alot soccer.
ACL on left knee in 1990.
ACL reconstruction on left knee in Nov. 2007 - achilles tendon allograft.

A few days ago I was leaving my apartment, I stepped down on a step to go down the stairs with my left foot and felt a sharp pain in my knee. I felt like my knee was not ready for the step. It also seems that my quadriceps strongly contracted at the same moment I touched down. The pain was quick, and went immediately away, after 15 minutes my knee became a little swollen and stiff.

It has been 4 days since the incident and my knee is still a little swollen and stiff. I have no pain anywhere, just soreness and can walk normally. Most of the swelling is on the outside and above the kneecap, it fills in that little pocket where the quad meets the joint. The muscles on the back of my knee are a little sore and there is a small bruise present on the back of knee as well.

My question is: did I tear or strain my ACL graft? What did I do?
Also, I have been doing proprioception/balance training for over a year...why did this happen to me? What can I do to improve the neuro-muscular connection in my knee?

Much thanks for any input.

Answer:

Hi there

I am an Australian Kinesiologist/sports therapist

I mentioned before to another ACL sufferer that Cruciate problems are often misdiagnosed and wrongly treated.
It is estimated that more than 75% of operations are performed unnecessarily, 35% are misdiagnosed and, in Australia alone, 18000 people lose their life because of medical mistakes.
It is estimated that these figures are the tip of the iceberg.
The most common causes of cruciate problems are muscular, with other words a muscle in under energy will tighten up causing it to foreshorten. This will pull bones out of alignment, causing stress on tendons and ligaments.
The other cause is Vitamin C deficiency. Connective tissue like tendons and ligaments need this vitamin to retain elasticity and produce collagen. Veins and arteries too, depend on Vitamin C to maintain elasticity and prevent cracking.
Cholesterol will be produces to patch up these cracks. (see website; Linus Pauling unified theory of cardio-vascular disease. Twice he received a Nobel prize and was declared one of the 20 top scientist in the country)
The muscles most often involved in cruciate issues are the Quadriceps, which run from the front of the hipbone, to the tibia, below the knee.
On the way down it attaches on the patella and hold this in position before continuing to the lower leg bone. If this muscle is overtight it pulls the kneecap and the tibia in an upward direction.
The other muscle is the tensor fascia lata, which runs from the front of the pelvis to the upper outside of the tibia, pulling sideways
This tightening of muscles is the main cause of meniscus problems, as the condyles of the bones do not line up correctly anymore, and neither do the cruciates, anterior and posterior.
That muscles can foreshorten, and pull bones ligaments and tendons out of alignment has been known for ages. It is called Arthritis.
When the hip muscles get out of alignment it causes wear and tear that could lead to hip replacement operations.
My recommendation would be Vitamin C, at least 2000 mg, and massaging the quads (Front of the upper leg) from center to insert and origin and do the same with the tensor fascia lata (outside of the upper leg).
Also massage the prominent knobs on the back of the pelvis (PSIS's). This will reset the muscles. Do these 30 seconds at a time and about 8 times a day.

Good luck

Hans de Rycke Fr.R.C.
'Bahk-Ge's Retreat'
Natural and Spiritual Healing Center

Answer:

Hi there

I forgot to mention the sources of my information. Here goes;
(A Comparison of Iatrogenic Injury Studies in Australia and The USA II:
Reviewer Behavior and Quality of Care) established a figure of 10 per cent adverse effects of all admissions to hospitals.

Concepts of human anatomy and Physiology, Kent M.Van De Graaff/Stuart Ira Fox

Touch for health, By John Thie DC, and Matthew Thie, M.Ed
Professional Kinesiology practice 1,2, and 3.

Quality in Australian Health Care Study
Examined OR Exposed?

Hans

Answer:

Thank you very mauch Hans. Can you suggest any exercises that will help restore normal muscle function so they stabilize my knee instead of causing misalignment of tendons and ligaments causing more damage? Much Thanks.

Answer:

Hi there

I would suggest avoiding dairy products. 80% of all the clients we see and do allergy testing on are allergic to dairy. This dairy allergy causes a range of health problems as long as your arm.
I usually tell our client that, if you came to our clinic in anything else but a pram, you are ready to stop suckling.
Following the massage suggestions will be the most beneficial thing you can do for yourself.

Hans

Answer:

Hi there -- I am an orthopaedic surgeon.

It sounds to me like you might have ruptured your quadriceps tendon. this commonly occurs during a hyperflexion eccentric quads loading - like missing a step when you go down the stairs - and is surprisingly often not that painful and has typically a palpable gap where the quads tendon inserts into the knee cap (patella).

I would strongly suggest seeing a doctor soon with this diagnosis in mind. if a quads tendon rupture is diagnosis late,e.g beyond a couple of weeks past the injury, it can be much more challenging to repair surgically.

sometimes if the diagnosis is not clear an ultrasound or an mri can be used to better visualize the tendon and determine if there is perhaps a partial rupture.

and yes, you could have reruptured your acl reconstruction, which, incidently, is an operation that i strongly support in patients that have ruptured their acl and have persistent knee instability leading to premature arthritis. don't get me wrong i think milk and vitamin c are good things too, but sometimes surgery is a better option. see: the millions of people that would be dead if they hadn't had surgery

all very hard to sort out without examining you...
best of luck

Answer:

Thank you for your reply smathes. Althought I am not sure it is a quad tendon rupture. I can walk normally with no pain, and fully extend leg with no pain. There is still minimal swelling and stiffness around knee. Knee stability is good, no giving way so I think my ACL is OK. I suspect that I strained the ligaments around my knee hence the swelling and stiffness.

Answer:

Hey friend, I’m sorry to hear about your injury. I have no qualifications to diagnose or treat your condition, but I want to throw in my two cents and suggest that you give consideration to the surgeon’s advice to get examined by a doctor. Here are some thoughts on the two responses you received:

1. The surgeon did not claim to be certain what your condition was, but only explained some of the potential risks you face if you do not seek proper diagnosis and treatment. He (or she; I will use he from here out for simplicity) recognizes that your injury may not require treatment, but your symptoms sound significant enough that you should investigate your condition further by visiting a qualified health professional with access to proper diagnostic tools. This is sound risk management advice.

2. Mr. Rycke sounds as if he has sufficient understanding of your condition and the proper treatment based on a single paragraph of description. This is comforting, especially when juxtaposed against the surgeon’s relatively dire warnings (not to mention up against the reminder that surgery could kill you; I’ll discuss that next). I'm just not sure if it's reasonable for him to make such a diagnosis based on the limited information he received.

3. Iatrogenic disease: let’s talk about it. Iatrogenic statistics are not designed to determine the specific cause of death or whether death necessarily *resulted* from a doctor’s mistake. A condition is considered iatrogenic if there is an error in treatment and a death occurred that could have been related to the error. It is crude at best to refer to iatrogenic figures as death “…because of medical mistakes." It gives people the impression that doctors are leaving screwdrivers in patients left and right and killing them by sheer negligence. Additionally, any reference to iatrogenic statistics should be considered along with the effectiveness, volume, necessity, complexity, and acknowledged inherent risks of surgical procedures. I applaud our surgeon friend for his patience and diplomacy in the face of such a misrepresentation (*not* suggesting that the misrepresentation was intentional).

Mr. Rycke’s extrapolation of Pauling’s work on vitamin C seems like a stretch (Pauling’s Nobel prizes were in quantum chemistry and molecular biology, not nutrition, and his vitamin C research was related to cardiovascular conditions rather than joint or ligament conditions) and his use of citations is a little odd (i.e., citing entire textbooks).

Get second opinions, treat every claim with skepticism, but don’t let unwarranted fear dissuade you from getting proper treatment.

Here’s a link to the iatrogenic study to which Mr. Rycke refers: http://intqhc.oxfordjournals.org/content/12/5/379.full.pdf

Here’s a link to a web page on Linus Pauling’s work: http://www.paulingtherapy.com/. It’s unclear to me if anyone related to Pauling endorses this site, however.

Here’s a link to criticisms of Pauling’s work: http://www.quackwatch.org/01QuackeryRelatedTopics/pauling.html